The cost of health insurance has skyrocketed for millions of Americans while Congress failed to agree on relief. But as open enrollment in the state’s health exchange comes to a close Thursday, Maryland boosted its sign-ups this year.

State officials consider it a feat — though a tenuous one that comes with threats that could drive up costs for all Marylanders.

“It shows people really want health insurance whether they are healthy or sick,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange. “They are doing what’s needed to keep health insurance.”

Most Marylanders get health insurance through their employers, but plans created under the federal Affordable Care Act have become an important avenue for the self-employed, small businesses and others to get coverage.

Once all those individuals and businesses are counted, whether they buy a plan on the state’s exchange or directly through an insurer, half a million people in the state now buy insurance under the act, commonly known as Obamacare.

About 3% more people signed up on the exchange this year, Eberle said.

She credited a state program to replace some of the federal subsidies that lapsed at the end of December.

It made the difference, Eberle said, but she noted some catches: The state subsidies last only a year, don’t cover everyone or replace every dollar of lost federal aid, and plenty of people bought cheaper plans that come with far higher out-of-pocket costs that some may not be able to pay.

And the final tally of enrollees could still drop, Eberle said. People who bought plans last year were auto-renewed and have a grace period to pay premiums and maintain the plans.

“Some will just not pay,” she said.

Thousands of Marylanders, many of them older people who didn’t qualify for state aid, already canceled their coverage. But they were more than offset by new enrollees, who tended to be younger and lower-wage earners who did qualify for assistance.

At the national level, 1.4 million fewer people are enrolled than last year, according to federal data.

People like Bobby Laughlin, a 32-year-old Baltimore resident, said the lack of clarity about costs made open enrollment stressful.

Laughlin works in a restaurant and installs HVAC systems, and neither job offers health insurance. He was relieved to learn the state would make up his lapsed federal assistance this year, bringing his monthly premium down to $70 from $450.

He called the higher cost “impossible” to afford.

“I’d have to downgrade my plan to a catastrophic plan without much coverage,” Laughlin said. “I’d not be able to go to the doctor, and I’d go into debt if I went to the emergency room. It would have changed my life and been a huge financial hardship.”

Even still, Laughlin said he worries about next year, when the state subsidies run out.

State officials had once estimated that tens of thousands of Marylanders would lose health insurance without the federal assistance, on top of direct increases in the price of their policies.

But people who are uninsured or underinsured are likely to skip needed or preventive care or take on financial debt. That also harms the health care system, which would push up costs and insurance rates for everyone.

Marylanders will have another opportunity to sign up for health insurance at tax time through a program called Easy Enrollment. That allows people to check a box on their state tax forms to get information from the exchange about plans and assistance they may qualify for.

Officials report that about 19,000 people have signed up for plans through Easy Enrollment since 2019.

The advocacy group Maryland Health Care for All announced a $100,000 ad campaign last week to make sure consumers know that they’ll have another chance.

“With so many negative changes in health care stemming from unfortunate federal actions, it’s great that Maryland continues to help people find affordable policies,” said Vincent DeMarco, the group’s president, during a news conference.

Democratic U.S. Sen. Chris Van Hollen said at the same event that nine other states have since created similar programs and that he is sponsoring a national version, in addition to pushing for continued federal subsidies.

Getting people covered in plans they can afford is critical, he said, or, “we all know what happens.”